Don’t Be The Swamp, Be The Drain

The healthcare crisis in our society is akin to a murky, stagnant, and overwhelming swamp. Having recently watched Will Smith and Martin Lawrence’s Bad Boys IV, I would add that the swamp is also crocodile-infested. The swamp is full of surprises—rarely good, but often bad and ugly.

As physicians, we find ourselves bogged down by the systemic issues that plague our profession. From the incessant administrative burdens to the emotional toll of patient care, physician burnout has become pervasive. This burnout has evolved into what is now being recognized as moral injury, defined as the profound psychological distress which results from actions, or the lack of them, which violate one’s moral or ethical code. This leads to physicians leaving the profession entirely, working reduced hours, and taking on nonclinical roles, to name a few.

However, instead of being consumed by the swamp, we must strive to be the drain—leaders and advocates for change, courageously working to revamp the system. The statistics on the current state of the healthcare system are alarming, but for forward-thinking individuals, this is a great opportunity for growth. I am not saying that we will be able to achieve system-wide change in our careers, but in our “ponds, rivers, and lakes”—our various places of work, we can be the change---we can be the drain.

The Swamp: Understanding the Healthcare Crisis

1. Administrative Overload: Physicians are inundated with paperwork, electronic health records (EHR) documentation, and regulatory compliance. These administrative tasks consume valuable time that could be better spent on patient care, leading to frustration and burnout. How often have you finished your day seeing patients, only to be faced with a mountain of paperwork that seems to grow daily? As a family physician, this has been my reality for over a decade.

Constantly juggling clinical duties with administrative responsibilities leaves little room for rest, often extending work hours late into the night. The irony is that while these systems were designed to streamline processes and improve efficiency, they often have the opposite effect, creating additional layers of complexity and frustration.

2. Inadequate Resources: Many healthcare facilities need to be more staffed and underfunded, forcing physicians to work longer hours with limited support. This affects the quality of care and exacerbates the stress and exhaustion felt by healthcare professionals. We must advocate for safe working environments and healthy healthcare systems. When resources are stretched thin, the consequences are felt throughout the entire system. Patients experience longer wait times and reduced face-to-face interaction with their doctors, leading to dissatisfaction and decreased trust in the healthcare system. Meanwhile, physicians are pushed to their limits, struggling to meet the demands of their practice with insufficient staff and outdated equipment. The lack of adequate support also means that essential tasks, such as follow-up care and patient education, often fall by the wayside, compromising the overall effectiveness of treatment plans.

3. Emotional Exhaustion: The emotional demands of patient care, compounded by the pressure to meet productivity targets and manage complex cases, significantly affect physicians’ mental health. Compassion fatigue and emotional exhaustion are common, further contributing to burnout. Each patient’s story of illness, struggle, and sometimes loss leaves a mark. The emotional labour of empathizing with patients and their families while managing our feelings of helplessness and frustration accumulates over time. The constant exposure to trauma and the need to remain stoic and professional in the face of it can lead to a numbing effect, where physicians feel detached and cynical—a classic sign of burnout. Unless one were a machine, it is impossible to separate oneself from the suffering we witness as physicians fully.

4. Systemic Inefficiencies: The healthcare system needs to be more efficient, from fragmented care delivery to misaligned incentives. Fragmented care delivery means that patients often receive care from multiple providers who need to be more effectively communicating with each other, leading to duplicated tests, conflicting treatments, and a lack of coordinated care. This disjointed approach wastes valuable resources and places additional strain on physicians who must navigate these complexities to provide comprehensive care. Misaligned incentives, such as those prioritizing quantity of care over quality, further complicate matters by encouraging practices that may not be in the best interest of patients. These systemic issues create barriers to providing optimal care and increase the burden on physicians.

Be the Drain: Leadership and Advocacy

I didn’t start my medical career with a plan to be a healthcare advocate. It was rather a choice thrust upon me. Either I sink to the bottom of the swamp, totally frustrated with the current healthcare system challenges, or create my path, and fight to stay alive and be heard. I would no longer accept a miserable, exhausting existence as a private practice physician. I was going to take my life into my own hands—and live my best life while still doing what I love. So, for you reading this article, note that the choice is yours, and you can start making that choice today. I have listed a few ways that you can start to be the drain and push for change.

1. Embrace Leadership Roles: Physicians must step into leadership roles within their organizations and professional associations. By actively participating in decision-making processes, we can influence policies and practices that impact our work environment and patient care.

2. Advocate for Systemic Change: Advocacy is essential in addressing the root causes of the healthcare crisis. Physicians can collaborate with policymakers, healthcare administrators, and patient advocacy groups to promote reforms that reduce administrative burdens, improve resource allocation, and streamline care delivery.

3. Foster a Supportive Culture: Creating a supportive work culture is crucial in combating burnout. This includes promoting work-life balance, providing access to mental health resources, and encouraging peer support. By fostering a culture of wellness, we can help our colleagues thrive.

4. Champion Innovation: Embracing innovative solutions can help address the inefficiencies in the healthcare system. Physicians can advocate for the adoption of advanced technologies, such as artificial intelligence and telemedicine, to improve patient care and reduce administrative burdens.

5. Educate and Empower: Physicians have a unique perspective on the healthcare system’s challenges. Educating our peers, patients, and the public about these issues can empower others to join the fight for systemic change. As physicians, we must recognize that we are highly educated, skilled, and experienced individuals, aware of the inherent weaknesses in our healthcare systems.

The healthcare crisis is a swamp, but we don’t have to be stuck in it. As physicians, we have the power to be the drain—leading the way towards a more efficient, effective, and compassionate healthcare system. It requires courage, determination, and a collective effort to advocate for the changes needed to reduce burnout and improve patient care.

Henry Ford once said, “Coming together is a beginning, staying together is progress, and working together is success.” We are stronger together, and we have more in common than what might seem like they are trying to divide us.